VAI TRÒ CỦA CỘNG HƯỞNG TỪ TRONG CHẨN ĐOÁN PHÂN BIỆT U MÀNG HOẠT DỊCH VÀ LAO KHỚPVAI TRÒ CỦA CỘNG HƯỞNG TỪ TRONG CHẨN ĐOÁN PHÂN BIỆT U MÀNG HOẠT DỊCH VÀ LAO KHỚP

Abstract

Purpose: To evaluate the magnetic resonance imaging (MRI) features in differentiating synovial tumor and tuberculosis arthritis. Material and methods: Descriptive study on MRI images of 13 patients, including 06 synovial tumor and 07 tuberculosis arthritis patients confirmed by synovial biopsy or joint surgery. Thickening and enhancement of synovial membrane, synovial fluid, bone erosion, bone marrow edema, edema and characteristics of periarticular soft tissue abscess on magnetic resonance imaging were compared between synovial tumor group and tuberculosis arthritis. Results: The mean age of synovial tumors group was 44.5±18.3, of the tuberculosis arthritis group was 60±15.5. The white blood cell count, neutrophil percentage and CRP of the synovial tumor group and the tuberculosis arthritis group were 7.9±1.7 (g/l), 64.3±14.5 (%), 1.5±1 (mg/l), and 8.7±3.5 (g/l), 70±8.1 (%), 4.6±6.5 9 (mg/l), respectively. The mean thickness of synovial membrane on MRI in the synovial tumor group was 19±10.4 mm, the largest was 36 mm, the smallest was 5 mm. In the tuberculosis arthritis group, the mean synovial membrane thickness was 8.9±6.7 mm, the largest was 24 mm, the smallest 5.7 mm, there was no statistically significant difference in synovial thickness between the two groups (p=0.07). In the synovial tumor group, there was 1 patient with thickness grade 1 (from 3 to 6 mm), the rest with thickness grade 4 (> 12 mm). In the tuberculosis arthritis group, there were 4 patients with grade 1, 2 patients with grade 2, and 1 patient with grade 4. Joint fluid was found in 2/6 patients with synovial tumor (accounting for 33%) and with clear fluid, and found only in 1/7 patients with tuberculosis arthritis (accounting for 14%) the fluid was not clear. Bone erosion was common in patients with tuberculosis arthritis (6/7 patients, accounting for 86%) while only 2/6 patients with synovial tumor (accounting for 33%) but the difference was not statistically significant (p=0.07). Bone marrow edema was found in 3/6 patients with synovial tumor (accounting for 50%) but in 6/7 patients with joint tuberculosis (accounting for 86%), the difference was also not statistically significant (p=0.21). There were no patients with soft tissue edema in the synovial tumor group, but there were 4/7 patients with soft tissue edema in tuberculosis arthritis (accounting for 57%), the difference was statistically significant (p=0.03). Similar to soft tissue abscess were not seen in the synovial tumor group, but for tuberculosis arthritis, there were 3/7 patients (accounting for 43%). Conclusions: Synovial membrane thickness and features of extra-articular lesions such as edema and soft tissue abscess provide useful information in differentiating synovial tumor from tuberculosis arthritis.